monthly billing statement - cigna · 6 sample invoice & user’s guide 9/2005 monthly summary...

Sample Invoice and User’s Guide

Monthly Billing Statement

Cat. #591797a 9/05 ©2005 CIGNA

CIGNA HealthCare

Monthly Billing StatementThis guide introduces our Monthly Billing Statement. The principle features of the invoice are described, including examples of the following pages:

■ Voucher Page

■ Monthly Summary

■ Summary of Account Activity

■ Summary of Current Costs

■ Account Level Summary of Current Costs

■ Adjustments – Summary of Eligibility Updates Processed

■ Adjustments of Client Reported Lives/Volume Changes

■ Adjustments – Summary of Retroactive Billing Line Changes

■ Current Subscribers

■ Eligibility Updates Processed

Each month, we will mail your billing package on the Normal Bill Day you selected when you established your profi le with us. If you fi nd that this date does not suit your needs, we can change your Normal Bill Day to another date that is more convenient for you.

If you have two or more billing locations (or if you have asked us to split up your billing for other reasons) we will send you two or more billing packages each month. Each billing package will be identifi ed by its own statement number.

Occasionally we may need to notify you of changes for prior months. For example, this will occur when you have retroactive changes to eligibility or structure.

If you have any questions regarding your billing package, please do not hesitate to contact your Employer Services Consultant, whose contact information is on your invoice.

Thank you again for choosing CIGNA HealthCare.

591797a 9/05 ©2005 CIGNA 1 Sample Invoice & User’s Guide 9/2005

2 Sample Invoice & User’s Guide 9/2005

Sample Invoice & User’s Guide 9/2005 3

Sample Invoice & User’s Guide

Voucher Page Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Voucher Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Monthly Summary Page Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Monthly Summary Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Summary of Account Activity Page Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Summary of Account Activity Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Summary of Current Costs Page Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Summary of Current Costs Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Account Level Summary of Current Costs Page Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Account Level Summary of Current Costs Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Adjustments – Summary of Eligibility Updates Processed Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Adjustments of Client Reported Lives/Volume Changes Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Adjustments – Summary of Retroactive Billing Line Changes Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Current Subscribers Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Eligibility Updates Processed Page Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Eligibility Updates Processed Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

TABLE OF CONTENTS


Voucher Page(Section 1 of Your Bill)

The fi rst page of each invoice is a voucher page, which should be used when you submit your monthly payment to the appropriate lockbox. This page refl ects the following:

Indicates your CIGNA HealthCare billing contact with mailing address and e-Mail address.

Contains your client identifi cation number.

The statement number will identify which invoice this is, if you have requested CIGNA HealthCare to split the billing into two or more invoices.

Contains the invoice number. This invoice number is an auto- and sequentially-generated unique number that can be used to identify a specifi c invoice.

Indicates the month represented by the invoice.

This is the date the invoice was printed. The bill will include all billing activity up to this issue date.

This is the date payment is due to be remitted to CIGNA HealthCare for the invoice; considered to be delinquent if payment is not received by the last day of the month.

This section will only appear if your invoice contains volume coverages that require you to fi ll in the open boxes on your invoice. This sentence is a reminder to return those completed pages of your invoice with your payment.

The bottom section of the voucher page should be mailed to the lockbox with payment.

Indicates the month represented by the invoice.

Please write in the number that is printed under the heading “Amount Due for Reported Months” on your monthly summary page. (Item O on page 7 of this user’s guide.)

Please repeat the number that you placed in the box labeled “Client Reported Amount Due” on your monthly summary page. (Item P on page 7 of this user’s guide.)

This total should be the same as the “Total Amount Due” on your monthly summary page. (Item R on page 7 of this user’s guide.)

Lockbox address where payment should be mailed.


Sample of Voucher

All samples used are for illustrative purposes only. Your invoice may differ in size, funding type combinations, structure, number of pages, etc., based on your specifi c information.


Monthly Summary(Section 2 of Your Bill)

This page of each invoice is a Monthly Summary, which shows the billing activity that has taken place since the previous month’s invoice was issued. This page shows:

■ The amount due that you reported during the past month for your volume coverages.■ Payments received.■ Any adjustments to the reported amount due for earlier months.■ The resulting balance due for the reported months.

The Monthly Summary provides a current status of the account and a summary of the billing activity during the month. If you have purchased volume coverages, space is provided on the Monthly Summary for you to enter the total amount due and the amount of payment required for the invoice.

Represents the account numbers associated with the invoice.

Balance due from the prior month’s invoice.

Summarizes the data you reported for previous months, for volume coverages (D + E).

These are the amounts you reported, by month, for volume coverages.

These are the adjustments you reported for prior months.

Grand total of all payments received since previous invoice.

If multiple payments are received, they will be listed with receipt date.

Due from the prior invoice plus any current reported amounts due, (including adjustments) less payments issued. (B +/- C - F)

Total amount of billed charges for the month.

The total adjustment amount calculated for prior months.

- Represents adjustments processed for the invoice by adjustment type.

Indicates any late payment charges due (ASO Only).

Totals Current Costs +/- Adjustments + Late Payment Charge. (I +/- J + N)

Space is provided for you to indicate the amounts due for volume coverages.

Our estimate of the amount due for this month based on your previously reported data.

Please write in the total amount due, which equals the payment required (O + P).

If you have purchased volume coverages, this message will appear if we have not received all the reported amounts required for the indicated month(s).

Billing contact name and phone number.


Sample of Monthly Summary Page


.

.


Summary of Account Activity(Section 3 of Your Bill)

This section of the bill is an OPTIONAL tool for your use in identifying Summary of Account Activity by account number, funding arrangement type, and by the total amounts due for the month. We can suppress the printing of this section upon request.

This section represents a summary of “account activity” for a billing period.

There are three funding types and this section summarizes monthly totals by funding type. The funding types are:

1. Insured – If CIGNA HealthCare HMO coverage has been purchased, it will be shown, for billing purposes only, with this funding type.

2. ASO – Administrative Services Only3. MP – Minimum Premium/AEB

This column refl ects the current monthly cost for those benefi ts that are billed based on the eligibility data you have given us.

This column refl ects the total adjustments by funding type.

Amount due.

This column represents the totals that you reported for volume coverages.

Account total.

This column represents the amount you reported for volume coverages.

Demonstrates the break-out of Summary of Account Activity by Account Number.

This is our estimate of the amount due for this month based on the client’s previously reported month’s data.

Grand totals for all account numbers broken down by funding arrangement type.

Late payment charges on ASO only.


Sample of Account Activity



Summary of Current Costs(Section 4 of Your Bill)

This section of the invoice IS PROVIDED when you have purchased volume coverages. It is RECOMMENDED when there are charges from claim or other sources associated with ASO funding that are not captured elsewhere. It IS OPTIONAL in all other situations. This section refl ects the detail by account, by branch, and benefi t option with the amounts due for the coverage month.

Account Number – if you have multiple account numbers, separate “current costs” sections will be produced.

“Current Costs” plus month of invoice.

All billing lines associated with the account and the branch are listed.

If network/party billing is applicable, network/party names appears in this section.

Funding type code appears in this section. (I = Insured, A= ASO, M = Minimum Premium/AEB)

Rate Tier (e.g. Emp, Emp + Spouse, Emp + Family = Tier 1, 2, 3, etc.)

If a box is provided, please insert correct amount for volume coverage. For the eligibility based billing lines the lives are automatically populated.

If a box is provided, please insert correct amount for volume coverage.

Month represented by the data. Script and Service Line data contain a lag in reporting due to availability of information. For Current bill type there is a one-month lag since the bill is released during the month of service. There is a two-month lag on Prior month bill types, since the bill is released prior to the month of service.

Billing rate associated with each benefi t.

Rate basis associated with each benefi t (e.g. per emp, per 1000, etc.)

If a box is provided, please insert correct amount for volume coverage. For all other billing lines, the amount due is automatically calculated.

Branch number and name.

Estimated information based on your previous month’s reporting.

If a box is provided, please insert total of all entries in column “L”.

Please insert total of any adjustments you are reporting for this invoice.

Please insert total of items “O + P”.

For illustration purposes only. We have the ability to bill at non-composite rate and composite rate level. This wording will not appear on the bill.

Amount due for emp/dep rate basis.

Amount due for non-emp/dep rate bases (e.g. per service line, per script, etc.)

Branch total due for eligibility based and manually closed lines. (S + T)

Special charges are located in this section.

Total amount due for special charges for specifi ed account and branch number.


Sample of Current Costs



Account Level Summary of Current Costs(Section 5 of Your Bill)

This page represents a summary of current costs for each branch by account number, and will be produced if the Current Costs section of the invoice is included in the monthly billing package, or if you have more than one account number.

Represents the account number for which the Summary of Current Costs is detailed.

Summary of the amounts you have reported for the specifi ed branch.

Summary of the eligibility-based and manually-closed amounts due for the specifi ed branch.

B + C.

Specifi ed Branch.

This is our estimate of the amount due for this month based on your previously reported data.

Total of the branch level reported totals listed above.

Grand total of all branch level charges listed above.

Note: If all billing lines are pre-populated before the invoice is released, this page will contain totals with no manual action required.


Sample of Current Costs Account Level Summary



Adjustments – Summary of Eligibility Updates Processed

(Section 6 of Your Bill)

This section of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section will refl ect a summary of eligibility adjustments processed by billing line that were eligibility-based billed and the applicable month of adjustment.

Sample of Adjustments – Summary of Eligibility Updates Processed



Adjustments of Client Reported Lives/Volume Changes


This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section will refl ect changes to lives and/or volume on the open billing lines that you have reported to us.

Sample of Adjustments of Client Reported Lives/Volume Changes

Month Adjusted

Old Volume/New Volume

Billing Line Changed

Rate and Rate Basis

Funding Basis

Amount Due

Old Lives/New Lives



Adjustments – Summary of Retroactive Billing Line Changes


This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this page represents all retroactive billing line changes to all billing lines. The page will refl ect:

Adjustments – Summary of Retroactive Billing Line Changes

Month Changes Occurred

Tier

Rate Basis

Billing Line Description

Old Lives/New Lives

Amount Due

Network/Party Name

Old Volume/New Volume

Funding Basis

Old Rate/New Rate



Current Subscribers(Section 9 of Your Bill)

This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section of the bill refl ects current subscribers on the current month invoice. The fi elds of information provided are:

Sample of Current Subscribers (not available for Summary bills)

Branch Number

Billing Line Description of Charges Per Subscriber

Rate Tier

Amount Due

Subscriber Name

Network/Party Name

Month

Subscriber Employee ID Number

Funding Basis Applicable to Each Benefi t

Rate Basis



Eligibility Updates Processed(Section 10 of Your Bill)

This page of the invoice IS OPTIONAL. We can suppress the printing of this section upon request. When selected, this section of the invoice refl ects all eligibility updates processed during the period identifi ed by subscriber. This section contains the same information as page 14 of the bill with the exception of the following:

Reason effective date – the date of the change.

Reason – this fi eld will indicate if the change was an addition, termination or reinstatement.


Sample of Eligibility Updates Processed (not available for Summary bills)



“CIGNA HealthCare” refers to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these subsidiaries and not by CIGNA Corporation. These subsidiaries include Connecticut General Life Insurance Company, Tel-Drug, Inc. and its affi liates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO Plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Virginia, HMO plans are offered by CIGNA HealthCare of Virginia, Inc. and CIGNA HealthCare Mid-Atlantic, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by Connecticut General Life Insurance Company.


Cat. #591797a 9/05 ©2005 CIGNA

monthly billing statement - cigna · 6 sample invoice & user’s guide 9/2005 monthly summary...

Documents